Posts Tagged health

The Powerful Combination of Physio and Fitness When Coming Back From an Injury

Being injured and in pain is the worst. It holds you back from performing activities you enjoy and even everyday tasks can be tougher to do to the standards that you’re used to. There are often also mental hurdles to overcome when trying to come back to sports or the training that you love.  

When you sustain an injury that needs physical therapy, this means that one or more of the body’s systems was not robust enough to handle a particular stressor it was up against at the time. 

This could be because of an exercise choice, too much of a particular activity over time, not be ready for the particular activity or simply fatigue that leads to less than ideal movement quality. There can be many reasons. Either way, the body was not resilient enough to fend off the stressor and it broke down. The best way that we know to build up resilience against injury is through fitness.

One of the biggest challenges that we can face when trying to navigate an injury and resume regular movement or training is knowing exactly what’s appropriate to do. When can we begin to veer off the rehabilitation road and flow onto the training highway?

The answer lies in a connecting the various professions that have the most to offer at ALL stages of your journey. Specifically, your physiotherapist and your strength and conditioning coach or trainer. 

For a long time there’s been a gap between physiotherapy and strength and conditioning when there is so much to gain when these worlds collide and there is a combined focus and collaborative effort towards not only getting you back to the activity that you most enjoy but also making sure that you are even more unbreakable in the future.

When you’ve been injured, you’ll need a physiotherapy lens at the site to examine the damage extent, get you out of pain and on the road back to function. Towards the end of treatment, your strength coach or trainer then merges into the game to deliver fitness strategies that should result in you needing fewer trips to the physiotherapist and the long term result of building resiliency against future damage.

The fact of the matter is, your physiotherapist can get you out of pain and back to normal, but they’re often not equipped with the tools to get you far stronger than you were and need. It may very well have been (and often is) a lack of strength and readiness for the activity that led to the injury in the first place.

Your strength coach can get you better than you were, stronger, faster, fitter and less damage prone, but they cannot directly apply the same healing and rehabilitation strategies.

Both of these skill sets have the same goal; to apply a certain stimulus and provoke a certain adaptation that results in you getting a little better. They just exist at different ends of the continuum.

Often, if you’ve been hurt what you need is some combination of the two skill sets working with you at the same time for best effect. 

Danny James, Head Strength & Conditioning Coach at Central Physio & Performance Fitness
Danny James, Head Strength & Conditioning Coach at Central Physio & Performance Fitness and can be reached at danny@centralperformance.com.au

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Should We Really Bother Foam Rolling So Much, Really?

For all the jazz around foam-rolling these days it may be surprising to know that the underlying mechanisms are still not well understood and there is a paucity of high-quality and well-designed studies available.

Some of the proposed mechanisms of effect may include:

1. Reflex neural inhibition

2. Increased stretch tolerance

3. Mediating pain-modulatory systems

What we do know is that foam-rolling appears to be effective for producing short-term gains in flexibility without reducing performance. And while the benefits to muscle function have not yet been established, there does seem to be a demonstrable reduction in post-exercise muscle soreness as a result of post-exercise rolling.

So, from the research that we do have, it’s safe to say that foam-rolling is perhaps not the miracle saviour for poor exercises choices or not moving enough that we once thought it was.

Reference:

1. A Meta-Analysis of the Effects of Foam Rolling on Performance and Recovery. Wiewelhove, et al. 2019

2. The Science and Physiology of Flexibility and Stretching : Implications and Applications in Sport Performance and Health. Behm, 2018.

Danny James, Head Strength & Conditioning Coach at Central Physio & Performance Fitness
Danny James, Head Strength & Conditioning Coach at Central Physio & Performance Fitness and can be reached at danny@centralperformance.com.au




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Is Your Phone Ruining Your Sleep?

Are you having trouble falling asleep?

A tonne of research has shown us that the use of electronic devices prior to sleep time can wreak havoc on our ability to fall asleep.

It turns out that the short-wavelength blue light emitted from smartphones, tablets, and other devices disrupts proper melatonin production.

Melatonin is a hormone released primarily by the pineal gland that regulates sleep-wake cycles. It is released at night and in conditions of prolonged darkness as a signal to the body that its night time.

Figueiro et al. 2012 looked at a small sample size of 13 individuals who used self-luminous tablets to read, watch movies and play games prior to bed.

The study concluded that light from these self-luminous displays 2 hours prior to bedtime diminished melatonin production by about 22%, possibly affecting circadian rhythms and normal sleep cycles.

Some things you can do to help not only get a good night’s sleep but help get to sleep in the first place include:

1. Develop a ‘POWER-OFF POLICY’ before bed

Switch off your electronic devices at least 1-2 hours prior to bedtime.

2. Develop a ‘Wind down’ routine before bed

Slow down and de-stress as much as possible before bed. Some other suggestions include taking a walk, meditating, reading a book, gratitude journaling.

3. A quite, cool, and dark place

Reduce any distracting noise, avoid warm clothing or bedding and aim for a temperature of approximately 18 degrees Celsius.

4. Avoid coffee, heavy meals and liquids before bed

Limit feelings of fullness, digestive discomfort and sleep disturbances due to late-night bathroom trips.

Danny James is the Head of Personal Training and Strength and Conditioning services at Central Physio and Performance Fitness, located in Surry Hills in the Sydney CBD area. danny@centralperformance.com.au

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What’s Better For Recovery From Strength Training? Whole Body Cryotherapy, Cold Water Immersion, or Placebo.

In our post on compression garments and recovery, we brought up the potential role of the placebo effect which sparked some questions and commentary.

Adding a little more to the placebo/recovery discussion, in a new study from Wilson, et al. 2019 compared the effects of cold water immersion (CWI), whole body cryotherapy (WBC) or a placebo (PL) intervention on recovery markers after a resistance training session.

Although a single training session does not reflect the everyday workload demands placed upon competitive athletes, there was substantial enough effect on the recovery markers used following the single training session to directly compare the three interventions.

What did they do?
24 males with a minimum training age of 12 months were matched into CWI (10mins at 10 degrees Celcius), WBC ( 3 and 4 mins at – 85 degrees Celcius) or PL group and performed a high volume lower body resistance training session at 80% of predicted 1RM.

Recovery markers were assessed before and after at 24, 48, and up to 72 hours post-exercise including ”Perceptions of soreness and training stress, markers of muscle function, inflammation and efflux of intracellular proteins.”

What happened?
The single training session did cause the expected perceptual soreness and muscle function disturbance with WBC managing to attenuate soreness at 24hrs and positively influencing peak force at 48 hrs post, greater than in CWI pr PL group. This has been a consistent finding in the literature to date: Stanley et al. 2012; Leeder et al. 2011; Versey et al. 2013; andRoberts et al. 2014.
It should be noted however that the WBC temperatures used in the study (- 85 degrees Celcius) were higher than those typically suggested (-110 to 140 degrees Celcius) possibly influencing results.

Aside from this small difference, it appears that ”many of the remaining outcomes were trivial, unclear or favoured the PL condition.”

The study concluded that while WBC may perform slightly better on some recovery indices following a single resistance training session, overall neither WBC or CWI performed better than the placebo treatment at accelerating recovery.

Readers should be aware that we are still not aware of the chronic effects of cold water therapies and that some research has suggested it can negatively interfere with vascular and muscular adaptations from resistance and endurance training while CWI has shown some small benefits for recovery from endurance protocols.

Danny James is the Head of Personal Training and Strength and Conditioning services at Central Physio and Performance Fitness, located in Surry Hills in the Sydney CBD area. danny@centralperformance.com.au

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Recovery (part 4): Compression Garments

Although a relatively recent addition in Australia, Compression Garments (CG) have rapidly become quite the fashion statement, initially designed to promote recovery from hard training and competition and subsequently to help improve performance.

Compression Garments are a type of tight-fitting form of clothing made from elastic material providing a gentle compression of the limbs. Some of the reported positive outcomes include:

  • Help Thermoregulatory control (maintaining correct body temperature)
  • Provides greater joint-position awareness
  • Enhanced local blood blow
  • Enhanced removal of post-exercise waste products
  • Enhanced muscle oxygenation
  • Reduced muscle oscillations
  • Reduced swelling
  • Reduced creatine kinase concentrations 
  • Reduced perception of post-exercise muscle soreness and fatigue

There is also the possible placebo effect and psychological aid of wearing CG and perceived recovery and performance improvements to be factored in, as anecdotally athletes often speak positively of their helpful effects. The magnitude of physiological recovery improvements observed in the literature are similar to what has been seen with cold-water therapies or light exercise.

While the research currently has shown some recovery benefits from wearing CG it should also be noted that a great deal of the research is of poor quality and clouded with inconsistencies.

It should be added that there is also the risk of bias due to sponsorshipship and potential financial gain.

While there have been some benefits shown and no observed adverse effects on performance or recovery with their use, there is still also no reliable criteria for best practice.  

It is therefore suggested that if CG are used they should be used as an adjunct to more proven and reliable recovery enhancing modalities such as enough quality food, good sleep hygiene, as well as fatigue and stress management strategies. Currently, the research is not strong enough to provide conclusive recommendations.

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Recovery (part 3): Stretching

Stretching has been tied to performance since the very beginning and currently, there is some evidence to suggest that there are small recovery benefits to be gained from post-exercise stretching.

For this instalment, we’ll be looking at some of the current evidence on stretching for recovery. Stretching to increase flexibility or as part of a warm-up will be covered in more detail another time.



The most common reasons for post-exercise stretching are to reduce soreness, help recovery and to regain pre-training flexibility, and while stretching is still common practice, much of the initial supporting theory has been debunked. 

Type

There are many types of stretching but the two categories most often subscribed to for recovery are static and dynamic. 

Static:(Self-administered, in place/no movement) 

Passive:(Partner administered) 

Dynamic:Active (movement based) 

Ballistic: Active / fast bouncy actions at end range)


Effects on Muscle Soreness 

A dig through the current literature will show that while there is some research suggesting positive results from post-exercise stretching on muscle soreness, much of it is low quality. While there is also widespread anecdotal observation of reduced muscle soreness with post-exercise stretching, there appears to be very little or no effect on muscle soreness reflected in the current body of evidence.


Blood Flow 

Static stretching appears to temporarily constrict the blood vessels through compression reducing blood flow, oxygenation and red blood cell delivery to the muscle. Shortly after the applied stretch, however, there appears to be a sudden and enhanced surge of blood flow greater than in pre-stretch conditions. This short-lived shunting effect may assist the recovery process through enhanced nutrient delivery and waste removal although this has not been firmly established in the literature.


Enhanced Parasympathetic Activity 

The PSNS is the branch of the Autonomic Nervous System associated with a ”rest and digest” response. Essentially, it slows the system down, reduces neural excitability and helps facilitate the recovery and adaptation process.
Static stretching has been shown to influence PSNS modulation, acutely (same day) and across several weeks after a consistent application over 28 days. This was demonstrated by positive changes to heart rate variability, which in recent times has become a popular metric for measuring ANS status and training readiness. 


Flexibility 

More research in recent times has pointed to static stretching leading to an improved stretch tolerance, rather than increased tissue flexibility. Some research has also suggested that improvements in flexibility may occur due to a temporary decrease in neural excitability or resting tone as a result of static stretching. Some newer evidence suggests that flexibility improvements may also be the result of change to the mechanical properties of the muscle-tendon unit through stretching.

In summary: 
. Static stretching has little to no effect on post-exercise muscle soreness

. Following post-exercise static stretching, a ‘shunting’ effect occurs resulting in a temporary increase in blood flow and waste removal.

. Static stretching promotes relaxation by enhancing PSNS activity.

. Static stretching creates short-term improvements in flexibility, and reduced neural drive.

While it appears that there are a few mechanisms through which static stretching can influence recovery, these changes are not meaningful enough to warrant using static stretching as a stand-alone, or primary method of recovery. 

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What To Do To Help Recovery

The four main components that we address when building a high-performance program are mindset, movement, nutrition, and recovery. With this post and the few to follow we are going to look at some things that you can do to influence an often overlooked but vital piece of the performance puzzle, recovery.
First up, here is a general overview.
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”Every training element has a point of diminishing returns. Our job (the coach’s job) is to find it shift emphasis and cycle back at the optimal point in time.” ~ Derek Hansen
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It’s important to understand that physical (and mental) exertion is a stress input that requires a recovery process and ultimately triggers a particular adaptation. Within the training realm, your workout is the stressor event. After a difficult session, there is an alarm reaction in the body caused by working out that results in a mobilising response, creates an inroad to your recovery and an acute performance decline. After this, a rebuilding period is required for the body to build back up to baseline and beyond in order to withstand future training inputs.
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The rebuilding or recovery stage is made up of the physiological events that occur between workouts and is helped along by good nutrition, enough sleep and various other activities that we’ll talk more about later.
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 If you’ve done enough to recover from your training inroads and adapted to a higher ceiling of resilience, you’ll notice a small increase in performance (faster time, longer distance, heavier weight etc). It can be said then that you’ve completed the cycle and gained a positive adaptation from your training.
You’ve gotten a little better, and so the cycle continues. Apply an appropriate and recoverable stimulus, and repeat.
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Stress + Recovery = Adaptation
…or 
Work + Rest = Success

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As you can see, improving performance is a delicate balance of measured training and healthy supporting habits to maximise the result of your efforts. Recovery is the necessary bridge between the work that you do and what you get out of it. You don’t progress from simply training alone.
 
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There are two parts to recovery: Rest and Regeneration.
Rest is an entirely passive strategy, involving a deliberate attempt to minimise planned movement and the mental and emotional duress associated with aiming one’s efforts at a long-term training plan.
Rest is aimed squarely on achieving physical and psychological recharge.
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Regeneration involves active, movement-based strategies used to minimise fatigue, replenish energy systems, encourage tissue healing and function, re-sensitise to the training stimulus, and speed up the recovery process.
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Some of these strategies include manual therapy, stretching, low-stress aerobic activity, and cold therapies to name a few.
 
We will discuss some of the strategies in the next instalment.
 
Stay tuned…
 

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Developing Key Athletic Qualities

At Central Performance we pride ourselves on helping our clients not only recover from injury but reach new levels of physical performance. In an earlier post we discussed how we classify movements into 6 basic patterns: hip hinge, squat, push, pull, rotation and gait. One of the other key considerations when designing our clients training programs is what physical and athletic qualities we want to develop. The key physical qualities we look to develop in our clients are:

  1. 1. Mobility
  2. 2. Strength
  3. 3. Power
  4. 4. Speed
  5. 5. Endurance

We find that in their own training clients have traditionally missed one or more of these categories. Classically it may be someone who loves jogging (endurance) and may occasionally do yoga (mobility) or lift weights (strength). However, they very rarely run fast or move explosively due to their focus on improving their endurance. This is unfortunate as power training, such as plyometrics, can have a positive effect of performance in endurance sports by improving movement efficiency. Conversely, we see some clients who love resistance training to develop strength, power and speed and also do yoga or some form of mobility training but avoid endurance training for fear it will reduce ‘gainz’. Similar to power training in endurance athletes endurance training in the right dose for people focused on strength and power development can have a significant positive impact by helping improve recovery and allowing more frequent or harder training.

Following the hierarchy of the Functional Movement System (FMS & SFMA) we look to clear mobility restrictions first in our clients. A restriction in mobility reduces the amount of proprioceptive feedback the Central Nervous System (CNS) receives from the mechanoreceptors (nerve endings that provide info on joint and body part positions) in the body. If the CNS is not receiving full proprioceptive feedback then it isn’t able use optimal muscle recruitment and movement patterns strategies, and this is when movement compensations occur. Optimising  mobility also allows for greater strength development. A restriction in mobility limits the range of movement over which a muscle can develop force, ultimately robbing the muscle of force. This is one reason why training movements like the deadlift and squat result in greater strength gains than using partial ranges of movement.

The next quality we look to develop is strength. We consider strength to be the master quality as it has a direct influence on power, speed and endurance. Power and speed both rely on the rapid development and application of force while endurance is the ability to produce force over a prolonged period of time. By increasing strength it increases the ceiling on the amount of power, speed and endurance a person is capable of displaying. An example of this is a rugby player who needs to be powerful when going in to make a tackle. If you are able to increase their level of strength, even without making any changes to their rate of force development (RFD – how quickly force can be developed) you have made them more powerful because they can now produce more force quickly. 

No wonder he’s so hard to tackle!

Another benefit of increasing strength in our clients is that it helps to build resilience and prevent injury. The literature on sports injuries shows a consistent theme that strength plays a protective role against injury. A prime example of this is the relationship between eccentric strength of the hamstrings and hamstring tears (eccentric strength is the ability of a muscle to produce force while it is being elongated or stretched). Most hamstring tears during sprinting occur at or just before ground contact while the knee and hip is rapidly extending and the hamstrings are having to produce force while rapidly being stretched. Increasing hamstring eccentric strength through exercises such as Nordic hamstring curls have been found to be protective against hamstring tears.

Power is the ability to quickly produce force and it is vital to improve performance in most sports. As mentioned above, one of the easiest ways to increase power is by increasing strength. Even without increasing RFD an increase in strength can cause a shift to the right (a positive thing) in the strength-speed curve.

Increasing strength can move everything to the right

Once a sufficient level of strength has been reached (1.5 x bodyweight squat is a good starting point for the lower body) more targeted power exercises can be very beneficial. The Olympic lifts and their derivatives, jumps, medicine ball work and kettlebell swings are some of the best and most popular power exercises. As mentioned above, power training can be very beneficial for athletes participating in endurance events, particularly running. By increasing power, especially RFD, running efficiency improves leading to improved running performance. By improving RFD a runner is able to have less ground contact time with each stride, meaning the muscles are working for shorter period of time and each stride becomes more energy efficient.

The big difference between power and speed is power is generally the application of force to an external implement (e.g. an opponent) while speed is how fast you can move your own body or limbs. For most people speed training will involve sprints or similar bodyweight only exercises and is the commonly missing element to our clients training programs. Seriously, when was the last time you sprinted flat out? Unless you are still actively involved in a sport chances are it was a long time ago that you last sprinted. However, speed is really important quality to maintain, especially as we age. Falls are one of the biggest health risks for people as they age, post-menopausal women in particular. One of the best falls prevention strategies is speed and power training. In a lot of falls the person trips or knows they are about to fall but are unable to move quickly enough to prevent falling. Maintaining speed training, especially as we age is extremely important. It is also a way to keep training enjoyable, running fast is fun.

Sprinting puts a smile on your dial

The final athletic quality we want to develop is endurance. Endurance training is probably the easiest and most commonly used form of exercise. It costs nothing to go outside and go for a walk or run, or a swim in the ocean and it is widely known that endurance training has lots of cardiovascular health benefits. Another added bonus is the positive effect endurance training can have on stress and recovery. Steady state cardio is a fantastic way to facilitate recovery from a heavy session of strength, power or speed training. Steady state cardio helps us to come out of the sympathetic nervous system (the fight or flight response) which is utilised in high intensity training and takes us more towards the parasympathetic nervous system (rest and digest response). By reducing our sympathetic drive and increasing our parasympathetic state we help recover from training and other daily stresses better.

Every person will require a different blend of the 5 athletic qualities. That blend will depend on their training history, their injury history and the requirements of the sport or day-to-day activities.

To design a suitable exercise program for our clients we start with a thorough movement screen and assessment as well as take an injury history and goal setting. From there we are able to build a program that addresses or clients weaknesses while also building on their strengths.

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